Ms Shauna Leigh Ketcham, ASW is a medicare enrolled "Social Worker - Clinical" provider in San Jose, California. Her current practice location is
441 Park Ave, San Jose, California. You can reach out to her office (for appointments etc.) via phone at
(408) 287-2460.
Ms Shauna Leigh Ketcham is licensed to practice in * (Not Available) (license number 79168) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1841798865.
Healthcare Provider's Profile
| Full Name | Ms Shauna Leigh Ketcham |
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| Gender | Female |
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| Speciality | Social Worker - Clinical |
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| Location | 441 Park Ave, San Jose, California |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1841798865
- Provider Enumeration Date: 01/24/2018
- Last Update Date: 01/24/2018
Medicare PECOS Information:
- PECOS PAC ID: 1951832633
- Enrollment ID: I20241004002982
Medical Identifiers
Medical identifiers for Ms Shauna Leigh Ketcham such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1841798865 | NPI | - | NPPES |
| 1871855916 | Other | CA | OUT- PATIENT MENTAL HEATH CENTER |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YM0800X | Counselor - Mental Health | 79168 (California) | Secondary |
| 104100000X | Social Worker | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | 79168 (* (Not Available)) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Ms Shauna Leigh Ketcham allows following entities to bill medicare on her behalf.
| Entity Name | County Of San Joaquin |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1215028931
PECOS PAC ID: 6002703436
Enrollment ID: O20050915001095 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Ms Shauna Leigh Ketcham is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Ms Shauna Leigh Ketcham, ASW
441 Park Ave,
San Jose, CA 95110-2615
Ph: () - | Ms Shauna Leigh Ketcham, ASW
441 Park Ave,
San Jose, CA 95110-2615
Ph: (408) 287-2460 |
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